Clinical decision making by beginning nurses: a naturalistic study

The ability to make accurate clinical decisions and implement appropriate nursing interventions is an essential component of nursing practice. Clinical decision making is the process nurses use to gather information about patients, evaluate it and make judgments that result in the provision of nursing care. However, competency in this area requires integration of knowledge and experience which occurs over time. Beginning nurses are expected to function in the clinical environment, making accurate clinical decisions. While they have had theoretical information in their educational process, they have had limited clinical experience. This presents the beginners with a difficult practice environment.

A naturalistic study was conducted to describe clinical decision making from the perspective of beginning nurses and to identify factors which were influential in this process. The study design was emergent, based upon the assumptions that the reality of the phenomenon is best understood through the lived experiences of the participants. A purposive sample of nine registered nurses with less than one year’s experience in acute care, medical-surgical nursing were interviewed. Four participants completed journals, recording additional experiences with decision making. These data were analyzed using Ethnography 4, identifying common themes among the participants. A comprehensive summary of the themes was returned to the participants for validation. The results are presented in a narrative format.

For beginning nurses, decision making is the foundation of their daily work. It is a difficult process for them, as they work to apply theory to clinical practice. Common themes emerged from the data: the role of experience; the importance of the interpersonal environment; the significance of interacting with physicians and the process of developing as a nurse.

Implications for education and practice were derived from these themes. In both these, it is essential to listen to the perspectives of the beginning nurses. It is important to foster interactions among practitioners from different levels of skill, encouraging beginners to reflect on their experiences. Beginning nurses need to be supported in transitions from the educational environment to the work environment, and throughout their careers, to maximize skill development in the process of clinical decision making.